Six NRT formulations are currently available. In the United Kingdom, all of these are now available on prescription through the NHS and most can also be bought over the counter at pharmacies. In addition, patch, gum, and lozenge formulations are on general sale in supermarkets and other outlets. As little evidence exists that any one of these formulations is more effective than any other or that any is more effective in particular subgroups of smokers, the choice of product should generally be guided by the smoker's preference and clinical considerations relating to duration of action.
NRT formulations and their availability
Evidence exists, however, that higher dose gum is more effective than lower dose gum in those smoking 20 or more cigarettes a day, that higher dose patches are more effective than low dose patches in those smoking more than 10 cigarettes a day, and that combining products (such as patch and nasal spray, or patch and inhalator) is more effective than using single agents alone. NRT, and nicotine gum in particular, has also been shown to help to control the weight gain commonly experienced after cessation.
NRT should be prescribed in blocks, usually of two weeks, be continued in those maintaining abstinence from cigarettes for a total of six to eight weeks, and then discontinued. If possible, NRT prescriptions should be linked to the delivery of follow up behavioural support. The prescriptions can be issued through delegated prescribing by nurses or other health professionals.
No evidence shows that gradual withdrawal of NRT is better than abrupt withdrawal. The risk of dependence on NRT is small, and only a small minority of patients (about 5%) who quit successfully continue to use medicinal nicotine regularly in the longer term.
Studies investigating the use of NRT to help smokers to abstain from smoking for certain periods (for example, at work or in a public place) or to reduce the number of cigarettes they smoke each day are in progress.
Prescribing details for NRT formulations